Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey

doi:10.4236/jct.2012.325100

Paper Menu >>

Journal Menu >>

Journal of Cancer Therapy, 2012, 3, 793-796

http://dx.doi.org/10.4236/jct.2012.325100 Published Online October 2012 (http://www.SciRP.org/journal/jct)

793

Feelings and Spiritual Practices of Patients with

Mastectomy: A Qualitative Study from Turkey

Gul Pinar

Department of Nursing, Faculty of Health Sciences, Yıldırım Beyazıt University, Ankara, Turkey.

Email: [email protected]

Received August 15th, 2012; revised September 18th, 2012; accepted September 25th, 2012

ABSTRACT

Purpose: This study was conducted to describe feelings and spiritual practices of patients with mastectomy. Method:

The study was employed a qualitative design at a private university hospital oncology unit in Ankara, Turkey.

Interviews were performed with 20 mastectomized women. Results: The findings indicated that commonly used in

several spiritual practices; prayer was used by 96%, of the patients, and 94% requested that others pray for their health,

the practice to positive reframing (76%), the practice to planning for family-friends activities (74%), visiting

mosque-shrine (73%), and the practice to reading Quran (71%). The categorization of the data led to identification of

three thematic units. The first we described as “Experiencing the consequences of illness as a disorder”. The second was

“Restoring a sense of order to life”, and the third was “Living with the new condition”. Conclusion: We concluded that

a having mastectomy was difficult for the subjects. In this respect, nurses’ role is vital to help women with breast cancer

in such a difficult and modifying process as breast removal.

Keywords: Feelings; Mastectomy; Spiritual Practice; Qualitative Study

1. Introduction

Breast cancer is the most common cancer of women,

comprising 23% of all female cancers around the globe.

Breast cancer incidence has been increased three times in

last decades in Turkey, incidence in western part of Tur-

key (50/100,000) is more than two times in eastern part

of Turkey (20/100,000) due to “Westernizing life” (in-

creased early menarche, late menopause, first birth > 30

years, smoking, alcohol consumption, oral contraceptive

usage, use of hormone replacement therapy for 5 years or

more, having miscarriages, aware of breast screening-

earlier diagnosis, less breast feeding leads to higher the

incidence in western part of Turkey), and other related

factors [1]. The physical and psychological results of a

breast cancer diagnosis can result in many changes in

quality of life [2]. Mastectomy is a common treatment

for breast cancer and deeply influence the perception of

women’s sexuality, body image and femininity [3,4].

Spirituality involve feelings of hope, love, connection,

inner peace, power greater than self, a value system, God,

cosmic consciousness, comfort and support [5]. For some

people, their spiritual practices act as a source of comfort

and strength in dealing with life's difficulties. Especially

people living with the illness may find it through a con-

nection to nature, through music and the arts, through a

set of principles [6]. These are reflected in the quality of

an individual’s inner resources. In recovery from illness,

spiritual applications can be helpful and powerful coping

mechanism in the prevention of illness including de-

creased tension-depression, and negative physical out-

comes [5,7].

In this sense, spirituality has been identified as factors

that contribute to management of chronic illnesses and

has become an increasingly popular concept among the

health-related literature, is regarded as part of nursing

practice [8,9]. Nurses consider spirituality as an impor-

tant component of holistic care [10,11]. Although interest

in the concept of spirituality and, especially spiritual

needs in people with cancer has increased, limited re-

search has targeted women who had undergone mastec-

tomy [12-15].

Objective

The purpose of the study was to describe feelings and

spiritual practices with women breast cancer.

2. Material and Method

2.1. Sample and Setting

Qualitative descriptive study conducted to describe the

spiritual practices experienced in living with mastectomy

from the perspective of patients with breast cancer from

Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey

794

January to December of 2010. Data were collected from

a convenience sample of 20 mastectomy patients par-

ticipated voluntarily at Baskent University Oncology

Unit in Ankara-Turkey.

2.2. Data Collection

A total of 20 mastectomized women at least 4 months

previously, had completed adjuvant cancer treatment and

had not experienced metastasis. In-depth semistructured

interviews using open-ended questions were carried out,

tape-recorded, and transcribed verbatim. The approxi-

mate duration of each interview was of about an hour and

a half. Data collection and inductive analysis occurred

concurrently. The research project was approved by the

Ethics in Research Committee of the Hospital of Baskent

University. Written consent was obtained from all par-

ticipants and the anonymity and privacy of the par-

ticipants were guaranteed.

2.3. Research Questions

In this paper, research question was as follows: cancer

experienced, feeling about the removal of your breast,

difficult times, meaning of spirituality, deeper own

spiritality, recognition of needs, spiritual coping stra-

tegies and practices, and interventions to respond to

spiritual needs, frequent use of spiritual behaviors or

practices.

3. Results

In all, 38% of the patients were premenopausal and <50

years (their ages varied from 36 to 70 years of age);

77.4% were married, 64.5% were housewives, 38.1%

were graduates of a basic education school, 68.8% had

children, 65.8% lived at home with her spouse and

children, and 60.4% had average incomes. The time since

mastectomy surgery varied between 4 months and 25

months. A majority (72%) had been diagnosed for more

than six months.

Histopathologic diagnoses were invasive ductal (76.2%),

invasive lobular (12%), and mixed type invasive cancer

(8.8%), respectively. Estrogen, progesteron, and HER-2

receptors were positive in 69.4%, 49.4%, and 18.2% of

patients.

The categorization of the data led to identification of

three thematic units. The first we described as “ex-

periencing the consequences of illness as a disorder”.

The second was “restoring a sense of order to life”, and

the third was “living with the new condition”. Patients

conveyed positive spiritual changes as a result of their

experience with breast cancer, and the women counted

on their spirituality to help them cope and derive mean-

ing from their disease experience. Most women (87%)

believed that spirituality was an important part of their

cancer treatment.

The findings indicated that several coping strategies;

prayer was used by 96% of the patients, and 94%

requested that others pray for their health, the practice to

positive reframing (76%), the practice to planning for

family-friends activities (74%), visiting mosque-shrine

(73%), the practice to reading Quran (71%), the practice

to go to a quite place (68%), the practice to use of

instrumental support/helping others (66%), the practice

to listening to or playing music (65%), the practice to do

exercises (44%), meditation and yoga (13%). Comple-

mentary and alternative medicine (CAM) was used by

nearly half of women (48%) after being diagnosed with

breast cancer. The most commonly used CAM practices

were herbal (94%), relaxation techniques (35%), and

vitamin and minerals (67%).

Looking at the Three Thematic Units

1) Experiencing the consequences of illness as a disorder;

losing a breast, feelings of shame, rejection and in-

feriority, a component and essential element of individu-

ality. Self-image was mentioned by all subjects as the

most important change. Psychological reactions related

to mastectomy and the subsequent functional losses

suffered have been noted. When confronted with breast

cancer, experience of women was very difficult and they

mostly felt grief. This behavior can be understood and

justified in our society we live in.

One respondent stated, “…Initially, I was in shock.

When I heard it first, I got rude awakening. I was so

anxious and afraid of dying. The doctor and nurse

convinced me to think pos itively. I knew that things were

not going to be the same anymore. I felt reducing the

sense of control on me. I thought about my children, how

are they going to handle this, then I thought that I need

to be stronger for them. I tried to look at this situation in

other perspectives, but of course it is not an easy

experience for me”.

Another respondent stated, “…The truth is, nothing is

like the way they were used to be before. Being not able

to change this situation makes me feel desperate. And

this feeling is too much for me to handle. Whenever I go

outside, I feel naked and ugly. I feel like people are

staring at me. So, I started to spend most of my time at

home. I prefer not to talk about it. My family were the

only ones who knew ab o ut my probl em”.

Another respondent stated, “…It really changed my

life. I used to love doing make up. But I can’t do it

anymore because of my disorder. After mastectomy, I

started to avoid to look at the mirror for several weeks. I

couldn’t feel like a women. I thought that no man would

ever like me again. I used to love to swim, but now I feel

Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey 795

shame of that because I scared to get negative reaction

from others. So , I gave up doing it”.

Another respondent stated, “…I used to find myself

beautiful and positive. But I can’t see these sides of me

anymore. I don’t feel special as a person. I become a shy

person after mastectomy, even when I’m with my

husband. This had never happened to me before. I’m

afraid my husband divorcing me. I feel that my

husbands’ thoughts has been changed since (she began

to cry)”.

2) Restoring a sense of order to life; this section

illustrates and demonstrates through the statements of the

participants being able to restore their lives.

One participant described, “…When it comes to health

care, I think it’s better for me to remove the breast

instead of remain ing the cancer. So, I prepared myself to

lose my breast. After that operation, I thanked God for

helping met o get rid of cancer. My family and my friends

had supported me a lot. In the main time, I have started

to go to work. Now I am using breast prosthesis. I feel

much better now ”.

Another participant described, “…I was nervous when

I heard that my breast is going to removed. But now, I

am okay with it. I’ve just started to see the good sides of

things”.

Another participant described, “…I passed experience

discomfort due to pain, fatigue sleep disturbance, and

nausea etc. But, I am still strong, so I think I can handle

this problem. Of course it’ll be hard for me to lose my

breast but I can move on”.

3) Living with the new condition; the participants of

the study, express clearly that the beginning was difficult

for them to accept their new condition.

One participant described, “…In the beginning it was

very difficult. I have been bothered because the cancer

and/or treatments have interfered with my ability to

perform activities. But in time I had some experiences

and now it is not that hard anymore. I learned lots of

things after mastectomy. My life has be en more meaning-

ful”.

Another participant described, “…I thought my life

was ruined. Because mastectomy affected my body image

in negative ways. My breasts were not equal so I couldn’t

wore light clothes a while. But then I started to fill my

bra and made them look normal. Now I don’t think that

my life is over”.

4. Conclusion and Recommendation

The results of this study concluded that a having mastec-

tomy was difficult for the women, and their perception of

functioning is closely related to emotional state. In

general, very few women believed in the possibility of

recovering and getting back to a normal life. They

concerned about their partner's and public’s reaction. The

most common feeling is anxiety, fear, disappointment,

alters patients’ body image and self esteem, impaired

sexual functioning, decreased social activities, with-

drawal and shame. Hence, nurses should physically,

emotionally and socially support these women and her

family before mastectomy for the adaptation process.

Also, nursing education should enhance nurses’ under-

standing and awareness of spiritual issues as part of their

daily routines. Future research could expand the research

to include a larger, more diverse group of women of all

ages who had underwent mastectomy with breast cancer.

5. Acknowledgements

The author wishes to thank all the nurses and doctors in

this study for their kind assistance to the present study.

The author thanks the patients for their cooperation.

REFERENCES

[1] V. Ozmen, “Breast Cancer in the World and Turkey,” The

Journal of Breast Health, Vol. 4, 2008, pp. 6-12.

[2] R. W. Carlson, B. O. Anderson, H. J. Burstein, et al.,

“Breast Cancer,” Journal of the National Comprehensive

Cancer Network, Vol. 3, No. 3, 2005, pp. 238-289.

[3] H. Karanlik, V. Ozmen, O. Asoglu, et al., “Long Term

Results of Surgical Treatment for Breast Cancer,” The

Journal of Breast Health, Vol. 2, 2006, pp. 89-95.

[4] M. Tuncer, “Significance of Cancer in Turkey, the

Burden of Disease and Cancer Control Policies,” M.

Tuncer, Ed., Cancer Control in Turkey, Ankara, Onur

Press, Health Ministry Publication, 2008, pp. 5-9.

[5] D. D. McKee and J. N. Chappel, “Spirituality and Medi-

cal Practice,” The Journal of Family Practice, Vol. 35,

1992, pp. 205-208.

[6] C. M. Puchalski and D. B. Larson, “Developing Curricula

in Spirituality and Medicine,” Academic Medicine, Vol.

73, No. 9, 1998, pp. 970-974.

doi:10.1097/00001888-199809000-00015

[7] D. Johnston and C. Mayers, “Spirituality—The Emer-

gence of a Working Definition for Use Within Health-

care,” Implicit Religion, Vol. 11, No. 3, 2008, pp. 265-

275.

[8] V. Skrzypulec, E. Tobor and A. K. Drosdzol, “Biopsy-

chosocial Functioning of Women after Mastectomy,”

Journal of Clinical Nursing, Vol. 18, No. 4, 2009, pp.

613-619. doi:10.1111/j.1365-2702.2008.02476.x

[9] N. K. Yıldırım, M. Özkan, S. Özkan, et al., “The Anxiety,

Depression and Quality of Life of Breast Cancer Patients

before and after Treatment: The Results of One Year

Prospective Study,” Neuropsychiatry, Vol. 46, 2009, pp.

175-181.

[10] J. Książek, A. Gaworska-Krzemińska and R. Piotrkowska,

“Psychological Support of a Cancer Patient Based on

Nursing Care Process Records,” Advances in Medical

Sciences, Vol. 52, No. 1, 2007, pp. 97-101.

[11] A. Narayanasamy, “The Impact of Empirical Studies of

Feelings and Spiritual Practices of Patients with Mastectomy: A Qualitative Study from Turkey

796

Spirituality and Culture on Nurse Education,” Journal of

Clinical Nursing, Vol. 15, No. 7, 2006, pp. 840-851.

doi:10.1111/j.1365-2702.2006.01616.x

[12] T. Zimmermann, J. L. Scott and N. Heinrichs, “Individual

and Dyadic Predictors of Body Image in Women with

Breast Cancer,” Psycho-Oncology, Vol. 19, No. 10, 2010,

pp. 1061-1068. doi:10.1002/pon.1660

[13] X. Chen, Y. Zheng, W. Zheng, et al., “Prevalence of De-

pression and Its Related Factors among Chinese Women

with Breast Cancer,” Acta Oncologica, Vol. 48, No. 8,

2009, pp. 1128-1136.

doi:10.3109/02841860903188650

[14] B. L. Den Oudsten, G. L. Van Heck, A. F. Van der Steeg,

et al., “Predictors of Depressive Symptoms 12 Months

after Surgical Treatment of Early-Stage Breast Cancer,”

Psychooncology, Vol. 18, No. 11, 2009, pp. 1230-1237.

doi:10.1002/pon.1518

[15] F. Anagnostopoulos and S. Myrgianni, “Body Image of

Greek Breast Cancer Patients Treated with Mastectomy

or Breast Conserving Surgery,” Journal of Clinical Psy-

chology in Medical Settings, Vol. 16, No. 4, 2009, pp.

311-321. doi:10.1007/s10880-009-9176-5